E coli outbreak toll grows, spreads to fourth stateTennessee health officials have confirmed an Escherichia coli O145 illness linked to a multistate outbreak, bringing to four the number of states affected, the US Centers for Disease Control and Prevention (CDC) said in an update today. It also said the number of patients with confirmed infections has grown to 23, 4 more than the previous total. Seven more probable cases are related to the outbreak, the CDC added. The latest illness onset is Apr 26. Of 30 patients with available information, the number of hospitalized patients remains at 12 (40%), and the number of patients who developed hemolytic uremic syndrome remains at 3. No deaths have been reported. An investigation into the source of the E coli is focused on a growing area in Yuma, Ariz. Two produce firms have recalled romaine lettuce products linked to the area.May 12 CDC update

Wisconsin researcher sanctioned for unauthorized Brucella workA University of Wisconsin-Madison veterinary professor has been barred from conducting lab work for 5 years after federal inspections found that he had been conducting unauthorized experiments on drug-resistant Brucella, the Wisconsin State Journal reported. The newspaper's report is based on information it received through a Freedom of Information Act request. The university learned of Dr Gary Splitter's work with antibiotic-resistant strains during campus-wide CDC lab inspections. His lab reportedly injected mice with the strain in 2007 or earlier without approval from local and federal agencies, according to the State Journal report. One of the lab's employees contracted brucellosis, but university officials don't know if it involved the strain used in the unauthorized experiments. The employee has recovered. The National Institutes of Health has called the incident a "major action violation," and the university has been fined $40,000. Splitter has countered that he wasn't aware of the work, done by graduate students, on the unauthorized strain. He has also said the university hasn't properly trained lab researchers on working with drug-resistant strains and that the school's biosafety program is understaffed. Brucella is a category B bioterror agent.May 11 State Journalstory

CDC issues Q fever alertThe CDC today issued a health alert to clinicians asking them to be alert for Q fever when evaluating febrile illness, pneumonia, or hepatitis in patients who have recently traveled to Iraq or the Netherlands. Q fever is increasingly reported in US military members deployed to Iraq, where the disease is endemic. A large ongoing outbreak in the Netherlands is also putting travelers to that area at risk, the CDC said. Q fever is a zoonotic disease caused by Coxiella burnetii, transmitted by aerosols or dust from infected animals such as cattle, sheep, or goats. An unexplained febrile illness along with pneumonia or hepatitis is the most common clinical presentation. Patients typically recover after about 2 weeks, but antibiotics can shorten the course. So far about 200 cases of Q fever have been reported in US military personnel, with several of them diagnosed after their return to the United States. In the Netherlands, an outbreak in goats primarily in the southern part of the country has been linked to about 3,700 human cases, though no cases have yet been diagnosed in returning American travelers. The CDC urges clinicians to report suspected and confirmed cases to local and state health departments.

Utah finalizing hospital triage pandemic guidanceUtah is in the process of finalizing hospital triage recommendations for pandemic settings and other public health emergencies, the Salt Lake Tribune reported yesterday. The guidelines were developed by the Utah Hospital and Health Systems Association for the Utah Department of Health. The guidance is based on a wartime triage model with a goal of providing the greatest good for the greatest number of people. In 2006 Utah's governor called for the guidelines as a component of the state's pandemic preparedness taskforce work. The guidelines include versions for both adult and pediatric settings. Released in January, most components have been approved except, for example, parts relating to the care of pregnant women. In the event of a public emergency declaration in Utah, the guidelines would also apply to clinics and other medical settings. Two of the issues the guideline group struggled with are how to triage people with dementia and patients who have do-not-resuscitate orders, the Tribune report said.May 11 Salt Lake TribunearticleUtah triage guidelines for adults